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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
90096-0132-01	Q0161	CHLORPROMAZINE HYDROCHLORIDE, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN	CHLORPROMAZINE HCL (USP,SUGAR-COATED) 25 MG	PO
72572-0360-25	J1953	INJECTION, LEVETIRACETAM, 10 MG	LEVETIRACETAM (SDV) 100 MG/1 ML	IV
72572-0370-25	J2001	INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG	LIDOCAINE HCL (25X5ML,PF) 1%	IJ
72572-0372-25	J2001	INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG	LIDOCAINE HCL (25X5ML,PF) 2%	IJ
72572-0380-25	J2060	INJECTION, LORAZEPAM, 2 MG	LORAZEPAM 2 MG/1 ML	IJ
72572-0415-10	J2185	INJECTION, MEROPENEM, 100 MG	MEROPENEM (SDV,USP) 500 MG	IV
72572-0416-10	J2185	INJECTION, MEROPENEM, 100 MG	MEROPENEM (SDV,USP) 1 GM	IV
72572-0427-01	J2248	INJECTION, MICAFUNGIN SODIUM, 1 MG	MICAFUNGIN SODIUM (SDV,PF,LYOPHILIZED) 100 MG	IV
72572-0430-25	J2250	INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG	MIDAZOLAM HCL (25X2ML,USP) 1 MG/1 ML	IJ
72572-0432-10	J2250	INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG	MIDAZOLAM HCL (10X5ML) 1 MG/1 ML	IJ
73070-0100-11	J1817	INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS	INSULIN ASPART 100 U/1 ML	IJ
73070-0102-15	J1817	INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS	INSULIN ASPART PENFILL 100 U/1 ML	IJ

HCPCS Code	Description	Billing Unit	SA Type
E1160 RR	Wheelchair, Fixed Full Length Arms, Swing Away Detachable, Elevating Leg Rests	Day	N
E 1221 RR	Wheelchair, Fixed Arm, Foot Rests	Day	N
E 1222 RR	Wheelchair, Fixed Arm, Elevating Leg Rests	Day	N
E 1223 RR	Wheelchair, Detachable Arms, Foot Rests	Day	N
E 1224 RR	Wheelchair, Detachable Arms, Elevating Leg Rests	Day	N
E1170	Amputee Wheelchair, Fixed Full Length Arms, Swing Away, Detachable, Elevating Leg Rests	Each	N
E1170 RR	Amputee Wheelchair, Fixed Full Length Arms, Swing Away, Detachable, Elevating Leg Rests	Day	N
E1171	Amputee Wheelchair, Fixed Full Length Arms, Without Footrests Or Leg Rests	Each	N
E2360	Power Wheel Chair Accessory, 22 Nf Non-Sealed Lead Acid Battery, Each	Each	N
E2360 RR	Power Wheel Chair Accessory, 22 Nf Non-Sealed Lead Acid Battery, Each	Day	N
E2360 U1	Power Wheel Chair Accessory, 22 Nf Non-Sealed Lead Acid Battery, Each	Each	Y
E2361	Power Wheel Chair Accessory, 22 Nf Sealed Lead Acid Battery, Each (E.G. Gel Cell, Absorbed Glassmat)	Each	N